Thesis (Ph. D.)--University of Wisconsin--Madison, 1973. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Situado no contexto da qualidade em saúde, este estudo versa sobre a decisão clínica e autonomia do paciente. Parte-se da premissa que, demais da competência técnica profissional e utilização de tecnologia adequada, o respeito aos direitos dos pacientes é atributo essencial à boa qualidade do atendimento médico. Tomando como exemplo a abordagem terapêutica do climatério, foi feita análise qualitativa do processo de decisão clínica, com base nas informações obtidas através de entrevistas semi-estruturadas com médico ginecologistas e com pacientes em fase de climatério. O propósito foi buscar apreender os valores dos médicos e dos pacientes e tentar compreender a lógica de seus comportamentos e atitudes, no que se refere especificamente aos papéis desempenhados por eles nesse processo. Com base nos resultados da análise, discute-se a complexidade da aplicação do princípio da autonomia na prática clínica e apresenta-se uma reflexão sobre a acreditação, como estratégia possível de contribuição a esse processo e à melhoria da qualidade do atendimento médico, por sua grande identificação como os aspectos relativos aos direitos dos pacientes, aos processos de educação permanente e à melhoria contínua da qualidade. / This research is set in the context of quality in health care. The object of the study was the patients role in clinical decision-making, considering that assuring good quality of clinical care requires respect to patients rights, as much as good technology. In order to study the decision process, we chose hormonal replacement therapy in the climacteric through qualitative analysis, based on non-structured interviews with gynecologists and postmenopausal women. The main purpose was the understanding of the values, attitudes and the reasoning employed by physicians and patients. The complexity of application of the bioethical principal of autonomy in daily clinical practice is discussed. The contribution of accreditation to these processes is examined, stressing the relevance of the functions related to patients rights, continuous education and continuous quality improvement.

Made available in DSpace on 2015-04-17T15:02:12Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2478876 bytes, checksum: de000c510d706f6a04c4191278376fd4 (MD5) Previous issue date: 2013-07-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The purpose of this study was to analyze the influence of religiosity in 139 patients between 25 and 75 years old which being treated for arterial hypertension in a family health program located in the city of Pedras de Fogo, Paraíba, in the period between December, 2011 and December, 2012. The sample included two groups: the Study Group, with 73 people that accepted to be part of the research, in which the religious activities were intensified; and the Control Group, with 66 patients that did not have any religion or did not accept the intensification of their religious activities. All of them had signed an informed consent for participation in the study and the clinical medical routine in both groups was maintained. It was applied: a clinical social-demographic questionnaire with a personal profile and the Scale Religious Attitude (Aquino, 2005) at the start and end of the nine months period. The analysis of the data was made in the program Statistical Package for the Social Sciences, version 18. Although there have been no significant reductions in the blood pressure in the subjects of the research, there was in the Study Group a decrease in the use of sedatives and antidepressants. Correlating some complaints that was reduced in a percentage in the Study Group with the intensification of religious activities, it was observed that: there is an inverse proportional relationship between prayer and chest pain (r = -0,259; p < 0,01), fear of death (r = -0,189; p < 0,05), and cold hands (r = -0,195; p < 0,05). Bad feelings (r = -0,235; p < 0,01) occurred less in the patients that took the communion and the recitation of the Rosary may have contributed to reduce dizziness (r = -0,217; p < 0,05). It was also observed a direct correlation between forgiveness and humor among the people who were the most religious of the sample (r = 0,233; p < 0,05) in the first step of the study. The evaluation of the reports points out mutual religiosity as a fator that improves the doctor-patient relationship. We have concluded that religiosity benefits people health in general, strengthening the trust of the patient in the doctor, and can be used as a therapeutic tool also in the field of mental health. / Este estudo teve como objetivo analisar a influência da religiosidade sobre a pressão arterial em 139 pacientes hipertensos com idades entre 25 e 75 anos, em uma unidade do Programa Saúde da Família, no município de Pedras de Fogo, Paraíba, no período de dezembro de 2011 a dezembro de 2012. A amostra foi composta por dois grupos: o Grupo de Estudo com 73 pessoas que aderiram ao protocolo da pesquisa, intensificando a atividade religiosa; e o Grupo Controle, com 66 pacientes que não tinham religião ou não aderiram à intensificação de suas atividades religiosas. Todos assinaram o Termo de Consentimento Livre e Esclarecido e mantiveram a rotina clínica de acompanhamento. Foram aplicados: um questionário clínico sócio-demográfico com dados pessoais e clínicos e a Escala de Atitude Religiosa (Aquino, 2005) no início e ao fim do período de nove meses. A análise dos dados foi realizada no programa Statistical Package for the Social Sciences, versão 18. Embora não tenha havido reduções significativas da pressão arterial nos sujeitos da pesquisa, foi encontrada no Grupo de Estudo uma diminuição do uso de antidepressivos e de indutores do sono. Ao correlacionar algumas queixas que reduziram percentualmente no Grupo de Estudo com as práticas religiosas que haviam sido intensificadas, foi verificado que: a oração foi inversamente proporcional à dor no peito (r = -0,259; p < 0,01), ao medo da morte (r = -0,189; p < 0,05) e às mãos frias (r = -0,195; p < 0,05). Os maus pressentimentos (r = -0,235; p < 0,01) ocorriam menos nos que comungavam e a reza do terço pode ter contribuído para reduzir as tonturas (r = -0,217; p < 0,05). Foi verificada correlação direta entre o perdão e o humor referido entre os mais religiosos da amostra (r = 0,233; p < 0,05) na primeira etapa do estudo. A avaliação dos relatos aponta a religiosidade mútua como fator que melhora a relação médico-paciente. Concluímos que a religiosidade traz benefícios à saúde geral das pessoas, fortalecendo a confiança do paciente para com o médico, podendo ser usada como ferramenta terapêutica complementar inclusive no campo da saúde mental.

Paediatricians and nurses belong to primary health care providers in the in child care while nurses have been taking over a key role in the primary health care. Their position is becoming stronger under the conditions of growing demands in the current health system. This survey was carried out as a combination of quantity and quality research. A questionnaire and an interview for nurses and parents was worked out as a major tool of the research. The survey included 102 nurses in paediatricians' offices. 112 parents and five nurses were interviewed in the range of the research work. There were six objectives set for the thesis. The first objective was to find out whether nurses in primary paediatricians' offices use nursing procedures. The hypothesis set up for the first objective was as of the following: nurses in primary paediatricians office do not use nursing procedures. This was proven on the grounds of the answers received in the survey. The second objective was to find out whether nurses keep their own nursing books and records. The second hypothesis set up was worded as of the following: Nurses in primary paediatricians' offices do not keep their own nursing records. This hypothesis was proven as well. The third objective was to find out whether nurses from primary paediatricians' offices visit families as a part of their service to families. The hypothesis for the third objective was worded as of the following: Nurses from primary pediatricians' offices visit patiens in their homes. The hypotehsis was proven on the groundsof the survey. The fourth objective was to find out whether nurses in primary paediatricians' office observe children in familes with bad socio-economic backgrounds. The hypothesis was worded as of the following: nurses observe children in familes with bad socio-economic;backgrounds. This hypothesis was proven as a fact. The fifth objective was to find out whether nurses are informed about community care. The fifth hypothesis was worded as of the following: nurses in primary paediatricians' offices are not informed about community care. This hypothesis was not proven. The sixth and the seventh objectives were to find out what the range of awareness about community care in parents' minds exists and whether parents are satisfied with nursing care provided by paediatricians and nurses. The hypotheses were worded as of the following: parents are not aware of community care and they consider paediatricians' and nurses' care substantial. The sixth hypothesis abot the range of parents' awareness of commuinity care was not proven, while the seventh hypothesis about satisfaction of nursing care by paediatricians and nurses was proven. In the frame of quality reasearch and on the grounds of four research questions two hypothese were set up. The first one is worded as of the following: Paediatric nurses in primary paediatric care consider community care as necessary and inevitable to provide a thourough care in familes with bad socio-economic backgrounds. The second one is worded as of the following. Paediatric nurses consider cooperation with nurses in other fields of the system as necessary and that eduaction towards well-being is desperately needed. Nurses should be aware of their roles within the health care system. They are no longer just nurses providing care and doers of doctors' commands. They have to learn how to operate successfully in other roles such as: managers, researchers, legislative assistants, advisors, educators and etc.

Att ha statistiskt säkerställda mått på slitstyrkan hos precisionsverktyg så som tryckeriraklar kan användas för att underlätta vidare utveckling samt marknadsföring av dessa produkter. I följande examensarbete har utveckling av en metod för att studera slitstyrkan hos tryckeriraklar genomförts. Studierna har genomförts i en testrigg som simulera en rotogravyrtryckeripress. Examensarbetets mål är att utveckla en metod för att testa slitstyrkan av olika rakelprodukter i testriggen samt att tillämpa denna metod för att få dokumenterade jämförande tester mellan fem olika produkttyper. Resultaten av testerna visar nötningen av rakelbladen med lamellängdförlust och viktförlust som mått på nötningen. Det resultat som definitivt kan konstateras är att Produkt C visar lägre slitage än Produkt A. Lamellängdförlust rekommenderas som mått på slitaget under fortsatta studier för att underlätta jämförelser mellan blad med och utan ytbeläggning. För att erhålla högre repeterbarhet rekommenderas fortsatta studier med avseende på färgens korrosivitet, temperatur och viskositet. Vidare studier rekommenderas även för olika färgtyper, då med mjukare pigment och längre testlängd för att se huruvida det ökar repeterbarheten. Vidare studier bör genomföras med avseende på de olika nötningsmekanismer som rakelbladen utsätts för under testerna. / Having statistically acquired measurements on the wear of precision tools like doctor blades can be used to assist further development and marketing of these products. In this thesis the development of a testing method for studying the wear on doctor blades has been conducted. The tests have been performed in a testing rig to simulate a rotogravure printing press. The goal of the thesis work is to develop a method for testing the wear resistance of five different doctor blade products in a testing rig and then applying this method to get a documented comparative study between the different doctor blade products. The results from the testing shows wear of the doctor blades using lamella length loss and weight loss and units of measurement.The results clearly show that Product C shows less wear than Product A. Lamella length loss is the recommended unit of measurement for measuring the wear on the doctor blades, this makes it possible to compare coated and uncoated blades. For a higher repeatability of the tests further studies are recommended with the paints corrosiveness, temperature and viscosity in mind. Further studies are also recommended into different kinds of paint, with softer pigments while increasing the test length. Further studies should also be performed to gain a greater understanding of the different wear mechanisms that contribute to the wear of the doctor blades during testing.

p. 1-201 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-09T18:13:44Z No. of bitstreams: 1 22222222222222222.pdf: 757908 bytes, checksum: d577f282d670e769654b34a06a68d529 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-13T13:49:56Z (GMT) No. of bitstreams: 1 22222222222222222.pdf: 757908 bytes, checksum: d577f282d670e769654b34a06a68d529 (MD5) / Made available in DSpace on 2013-05-13T13:49:56Z (GMT). No. of bitstreams: 1 22222222222222222.pdf: 757908 bytes, checksum: d577f282d670e769654b34a06a68d529 (MD5) Previous issue date: 2004 / A educação em saúde envolve distintas concepções de educação, de saúde e de homem, segundo as quais dois modelos de prática educativa são delimitados: o hegemônico e o dialógico. O primeiro modelo visa a prevenção das doenças e agravos mediante o repasse de conteúdos biomédicos para redução de riscos individuais. O modelo dialógico tem como ponto de partida o indivíduo e sua realidade. Este é reconhecido sujeito da prática educativa, cuja orientação é o desenvolvimento de sua autonomia no cuidado com a própria saúde. Este enfoque é propiciador de práticas educativas socioculturalmente sensíveis. Em conformidade com o princípio da integralidade, a educação em saúde constitui uma das atribuições básicas de todos os profissionais do Programa Saúde da Família (PSF). Espera-se que a prática educativa seja desenvolvida na oportunidade dos contatos com os usuários e a comunidade. O presente estudo teve como objetivo identificar e caracterizar a ação educativa em consultas médicas. Analisaram-se as transcrições literais de 100 consultas: 50 com pacientes hipertensos e 50 com crianças menores de seis anos de idade, conduzidas, respectivamente, por dez médicos do PSF de três municípios baianos. Os resultados apontam ser a atenção clínica no PSF orientada, predominantemente, pelo modelo biomédico. A centralidade conferida ao indivíduo, à doença e à remissão dos sintomas constitui evidência de uma concepção de saúde equivalente à ausência da doença. As narrativas dos pacientes e das famílias são inibidas pelo discurso médico, tornando a consulta impermeável às dimensões psicossocial e cultural do processo saúde-doença-cuidado. A narrativa médica é de conteúdo imperativo: a definição do projeto terapêutico é centralizada no profissional, sem negociação com o paciente. A ação educativa se caracteriza como prescritiva e descontextualizada das condições concretas de vida dos pacientes. O modelo hegemônico de educação em saúde predomina, mas ações orientadas para o desenvolvimento da autonomia dos pacientes, ainda que pontuais e relacionadas a idiossincrasias do profissional, também podem ser identificadas. Conclui-se que os médicos do PSF não têm assimilado em sua prática clínica a natureza integral que constitui eixo de reorientação do modelo assistencial, o que remete à necessidade de capacitação destes profissionais para o diálogo com a diversidade cultural. / Salvador

The primary aim of the study is to investigate the effectiveness of professional teacher development for a group of teachers at full-service schools (FSSs), who are the implementers of inclusive education according to Education White Paper 6, the inclusive education policy in South Africa. The researcher used ontological and epistemological assumptions, as well as specific social research methodologies. This created a scientific grounding for the findings of the study. The methodology included a qualitative research approach and research design. Focus group interviews and observation were used for data collection. In this study purposive sampling was used. The participants in this study were chosen because of their teaching experience at full-service schools; sampling was therefore done with a purpose. Phenomenology is used in the study to decide what happens in the lived experiences of the focus group interviewees, who were teachers at full-service schools. This helped the researcher to better understand the needs and problems of the participants. During qualitative data analysis the information was organised, arranged and prepared systematically and classified into themes and categories and then coding followed. The analysis showed that in the absence of an appropriate model for professional teacher development for FSSs, the teachers at the schools were not in a position to implement inclusive education adequately. The researcher proposes a framework that is based on the ecological systems theory of Bronfenbrenner, taking the intervention collaborative framework designed by the researcher based on findings and recommendations into consideration. The collaboration among stakeholders in the different levels would encourage teamwork in the development of the FSS teacher. The full-service school teacher is influenced by various elements, the learner with diverse needs in the classroom, members of the management team, the school-based support team and colleagues at school. Members of the district-based support team, the school governing body, as well as members from the wider school community all have an influence on a teacher’s development as a professional person. / Inclusive Education / D. Ed. (Inclusive Education)

xii, 163 p. / The principle of respect for autonomy has been the center of gravity for the doctor-patient relationship for forty years, replacing the previous defining concept of physician paternalism. In this work, I seek to displace respect for patient autonomy with narrative and phronesis as the skills that must be mastered by the physician to engender a successful therapeutic clinical relationship. Chapter I reviews the current state of affairs in the philosophy of medicine and the doctor-patient relationship and explains how and why autonomy has become so central to physicians' understanding of how to conduct a clinical encounter with a patient. Chapter II argues that "respect for autonomy," while remaining a valid rule to be considered in some clinical relationships, cannot be the central concept that defines the relationship both because it fails to describe accurately human selfhood and also because it empirically lacks universal applicability--many humans, and most seriously ill patients, actually lack autonomy. Shared decision making, an autonomy-based model of the doctor-patient relationship, suffers from this critique of autonomy as well as its own shortcomings in that it maintains a strict fact/value distinction that is untenable. Chapter III introduces narrative philosophy and its extrapolation, narrative medicine, as a possible alternative to an autonomy model of care. I defend a narrative view of selfhood, while recognizing that even if we are in some sense narratively constituted, this still leaves many questions regarding the relationship between story and self, particularly in a clinical encounter. In Chapter IV, I seek to limit the claims of narrative by arguing that story and self can never be fully equated and that narrative must be understood as demonstrating alterity rather than eliminating it. In Chapter V, a new conception of the physician's role in the doctor-patient relationship is presented, combining phronesis, or practical wisdom, with narrative skill in four aspects of the clinical encounter: diagnosis, treatment, assistance in medical decision making, and emotional support of the patient. / Committee in charge: Naomi Zack， Chairperson； Cheyney Ryan， Member； Mark Johnson， Member； Mary Wood， Outside Member

A large part of the work has been devoted to regulation fees as one of the health care systems regulating mechanisms. An essential place in the work is taken by elaboration of the topic of increase of costs for the health care systems functioning in the current world and the possibilities of their solution. The work also deals with an extensive and frequently discussed topic of justice in the physician-patient relationship. This topic has been processed in connection with historical circumstances and a philosophical dimension of perception of justice in health care. Further to this, ideas and ideological foundations of justice, which project into political ideologies, have been dealt with. Health care systems, the system of health insurance in the Czech Republic and its legal regulation have been briefly characterized. The aim of the work was to map an opinion of some ordinary citizens regarding perception of justice in the Czech health care and introduction of the regulation fees. Partial goals were to find out in what way political orientation reflects in the opinion on justice of the collected regulation fees and furthermore to map, in what way an amount of income of respondents influences an opinion that regulation fees represent an income for a health care facility. Two hypotheses were determined. Hypothesis no. 1: University graduates understand better the system of regulation fees. Hypothesis no. 2: More than 80% or respondents consider it unjust that regulation fees represent an income of a physician, health care facility, or pharmacy. A method of questioning was used for the processing, data collection was carried out by using a questionnaire technique. Statistical methods suitable for an analysis of categorical data were used for evaluation of information. 300 questionnaires were handed out, the return rate being 74%, the final research population consisted in 182 respondents from the city of Votice. Another employed processing method was the secondary data analysis. Results of the questionnaire research brought a number of intriguing facts relating to attitudes of the respondents as to the issue of justice and state of the Czech health care. Further to this, it has been confirmed that university educated respondents understand better the system of regulation fees. In more than 65%, respondents consider it unjust that the proceeds from the regulation fees collection represent income of a health care facility. One of the hypothesis was confirmed and the other was disproved. The acquired information can be used as a guideline for public discussion.

Situado no contexto da qualidade em saúde, este estudo versa sobre a decisão clínica e autonomia do paciente. Parte-se da premissa que, demais da competência técnica profissional e utilização de tecnologia adequada, o respeito aos direitos dos pacientes é atributo essencial à boa qualidade do atendimento médico. Tomando como exemplo a abordagem terapêutica do climatério, foi feita análise qualitativa do processo de decisão clínica, com base nas informações obtidas através de entrevistas semi-estruturadas com médico ginecologistas e com pacientes em fase de climatério. O propósito foi buscar apreender os valores dos médicos e dos pacientes e tentar compreender a lógica de seus comportamentos e atitudes, no que se refere especificamente aos papéis desempenhados por eles nesse processo. Com base nos resultados da análise, discute-se a complexidade da aplicação do princípio da autonomia na prática clínica e apresenta-se uma reflexão sobre a acreditação, como estratégia possível de contribuição a esse processo e à melhoria da qualidade do atendimento médico, por sua grande identificação como os aspectos relativos aos direitos dos pacientes, aos processos de educação permanente e à melhoria contínua da qualidade. / This research is set in the context of quality in health care. The object of the study was the patients role in clinical decision-making, considering that assuring good quality of clinical care requires respect to patients rights, as much as good technology. In order to study the decision process, we chose hormonal replacement therapy in the climacteric through qualitative analysis, based on non-structured interviews with gynecologists and postmenopausal women. The main purpose was the understanding of the values, attitudes and the reasoning employed by physicians and patients. The complexity of application of the bioethical principal of autonomy in daily clinical practice is discussed. The contribution of accreditation to these processes is examined, stressing the relevance of the functions related to patients rights, continuous education and continuous quality improvement.